IJTRR 2016; 5 (5): 233-239
Original Research Article
doi: 10.5455/ijtrr.000000212
International Journal of Therapies & Rehabilitation
Research
http://www.scopemed.org/?jid=12
E-ISSN
2278-0343
INFLUENCE OF AEROBIC EXERCISE AND RESISTANCE TRAINING
IN MANAGEMENT OF OBESE FEMALES
Mohammed EL GENDY 1, Amir WADEE 2, Amal EL-SHEIKH
3,
*
1
2
Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
3
Department of Physical Therapy, Mahala General Hospital, Cairo, Egypt
ABSTRACT
Background/aim: Metabolic complication of obesity is rising not only in developed countries but
also in non developing countries. In fact, Obesity can be presented as (new world syndrome) the greatest
health problem in the modern industrial world.. The aim of this study was to investigate the influence of
Aerobic Exercise and Resistance Training in Management of obese females.
Material and methods: Forty-five obese females participated in this study. Obese females were
allocated randomly into three groups; group A, B, and C, fifteen obese females in each group. Group A
received aerobic exercise only, group B received resistance exercise only, and group C received combined
(aerobic and resistance) exercise. The study lasted for four weeks, Fasting lipid profile was measured
before and at the end of the study for the three groups.
Results: statistical analysis revealed that there was significant improvement in fasting lipid profile in
the three groups with a greatest improvement to group c.
Conclusion: Aerobic, resistance and combined training are effective methods for treating
dyslipidemia in obese females.
KEY WORDS:
Metabolic complications, Aerobic exercise, resistance training, Fasting lipid profile.
Dr. Amal EL-SHEIKH
Department of Physical Therapy, Mahala General Hospital,
Cairo, Egypt
IJTRR 2016; 5 (5): 233-239
INTRODUCTION
Obesity is a complex multifaceted disease that
is influenced by genetic, epigenetic, environmental, and
behavioral factors. It results from long-term imbalance
between energy intake and energy expenditure,
favoring positive energy balance. When energy intake
chronically exceeds energy expenditure, the resulting
imbalance causes expansion of lipid storage and favors
adipogenesis (1).
Obesity has turned into a worldwide epidemic.
In the last decades the number of obese patients has
increased considerably. It is especially alarming that in
recent years the increase was most pronounced in
children and that it occurs both in developed, but
perhaps even more, in developing countries (2).
The typical dyslipidemia of obesity consists of
increased triglycerides (TG) and FFA, decreased HDLC with HDL dysfunction and normal or slightly
increased LDL-C with increased small dense LDL. The
concentrations of plasma apolipoprotein (apo) B are
also often increased, partly due to the hepatic
overproduction of apo B containing lipoproteins (3).
Treatment of obesity-associated dyslipidemia
should be focused on lifestyle changes including weight
loss, physical exercise and a healthy diet. Lifestyle
changes synergistically improve insulin resistance and
dyslipidemia. Physical exercise without diet restriction
or weight loss has evidenced improvements in blood
lipids profiles and to decrease fat mass (4, 5).
Exercise training has specifically been reported
to induce changes in blood lipids and lipoproteins in
other non obese populations, including reductions in
total cholesterol (TC), low-density lipoproteincholesterol(LDL-C) and triacylg-lycerols, and increased
high-density lipoprotein-cholesterol (HDL-C) ( 6).
Metabolic complication of obesity is rising not
only in developed countries but also in developing
countries.In fact, obesity can be presented as (new
world syndrome) the greatest health problem in the
modern industrial world. The prevalence of this
complication is increasing in all age groups in the world.
Significant changes that occur from adolescence to
middle age affect health and can increase the tendency
to the disease. Severe obesity is associated with
increased mortality (7, 8).
Obesity reduces vascular compliance and work
with the stiffness and hardness and increased
resistance to blood vessels in the long term and by
factors such as additional energy absorption, low used
energy, low level of basal metabolism, reduce fat
oxidation, and sympathetic activity. The researchers
reported that obesity and decreased levels of Highdensity lipoprotein (HDL) and increased Low-density
lipoprotein (LDL) levels and triacylglycerol are the
factors related to heart disease (9, 10).
Regular exercise may cause a gradual
reduction of triglycerides (TG), total cholesterol (TC),
LDL, Body Mass Index (BMI), body mass, body fat and
increased HDL, body mass, and Basal Metabolic Rate
(BMR). A low-calorie diet improves the lipid profile,
which if combined with exercise, is targeted at
improving body composition. People who associated
diet with physical activity achieve better results in
reducing body fat, particularly visceral fat than in other
areas affected by activities (11).
The short- and long-term effects of aerobic exercise and
resistance training in normolipidaemic subjects and
hyperlipidaemic patients. The ESC concluded that it has
not yet been established how much exercise is required
in order to improve the lipid profile and reduce
cardiovascular risk. The lack of evidence for training
programmes that optimally improve cardiovascular risk,
drawing particular attention to the effects of aerobic
exercise, resistance training or both on cardiovascular
risk factors(12, 13).
MATERIALS AND METHODS
Forty five obese females, aging from 25 to 50
years, lipid profile was evaluated before and after
treatment sessions. These women were randomly
allocated into three groups: Group A:Fifteen obese
females performed aerobic exercise only. Group B:
Fifteen women performed resistance exercise only.
Group C: Fifteen females performed combined exercise
(aerobic and resistance training). Fasting lipid profile
was measured before and at the end of the study for
the three groups. Written informed consent was
obtained from each patient. Age, weight, height, and
body mass index of the patients were recorded. The
study was designed as a prospective randomised
clinical trial.
Group A (aerobic exercise): According to
maximum heart rate they received aerobic training at
mild to moderate intensity at 65- 80% of predicted
maximum heart rate (predicted maximum heart rate=
220 – age), duration about 40 minutes consisted of
warm up phase consisted of slow walking on treadmill
for 5- 10 minutes, training phase for 20-30 minutes on
intervals increased gradually till reaching 30 minutes at
the end of the forth weak, cooling down phase in the
form of slow walking on treadmill for 5 minutes. This
exercise training was done 3 days/ week for four weeks
(14, 15 ,16)
Group B (resistance exercises): According to
the one repetition maximum (1-RM) which is defined as
the maximum amount of weight that can be displaced in
a single repetition for each muscles group for each
patient participated in resistive training.
They received 30-min of resistance exercise in
the form of (four sets of 8–12 repetitions at 10-RM for
leg press, leg curl, bench press and rear deltoid row,
with each set completed in approximately 30-sec with
1-min rest) with the 10-RM level determined during the
initial session (17).
Starting workload levels for each piece of
equipment will be tested by participants and if more
than 10 repetitions will be achieved, the weight will
increase and after a short rest participants tried again.
Likewise, if less than 8 repetitions were achieved, the
weight was decreased and after a short rest
participants tried again.
Group C (combined exercises):This is a
combination of 15-min aerobic exercise (walking by
IJTRR 2016; 5 (5): 233-239
using treadmill) and 15-min of resistance exercise (two
sets of each exercise in the form of leg press, leg curl,
leg extension, bench press and rear deltoid) (17).
Statistical Analysis
A statistical package program was used to
evaluate the data obtained from the study. Descriptive
statistical methods (mean, and standard deviation)
were used in the evaluation of research data as well as
the Kolmogorov–Smirnov distribution test for examining
normal distribution. In comparing quantitative data, the
ANOVA test was used in intergroup comparison of
parameters. The Paired samples t-test was used for
intragroup comparisons. The results were calculated at
the 95% confidence interval, P < 0.05 significance level
and P < 0.01 advanced significance level.
Results
No study participant left the research project for
any reason. No side effects or complications were
observed during the treatment. Baseline characteristics
of the patients are shown in Table 1. Group A: Their
mean ± SD age, weight, height, and BMIwere31.13 ±
4.25years, 85.09 ± 6.29kg, 161.13 ± 3.64cm, and 32.26
± 1.53kg/m². Group B: Their mean ± SD age, weight,
height, and BMI were 32.53± 5.09 years, 82.95±
4.92kg, 162.8± 3.48cm, and 31.33± 1.39kg/m². Group
C: Their mean ± SD age, weight, height, and BMI were
32.6 ± 6.17 years, 83.64 ± 5.03kg, 161.8 ± 2.59cm, and
31.8 ± 1.47kg/m².
Comparing the general characteristics of the
subjects of the three groups revealed that there was no
significance difference between groups in the mean
age, weight, height, and BMI (p > 0.05).
There was a significant difference between the
three groups in the mean value of TC post treatment (p
= 0.0001), as shown in Table 2.
There was no significant difference between
the three groups in the mean value of triglycerides post
treatment (p = 0.15), as shown in Table 3.
There was a significant difference between the
three groups in the mean value of LDL post treatment
(p = 0.0001), as shown in Table 4.
There was a significant difference between the
three groups in the mean value of HDL post treatment
(p = 0.001), as shown in Table 5.
Table 1. Baseline characteristics of the patients.
Group A
Group B
Group C
p
(n = 15)
(n = 15)
(n = 15)
Age (years)
31.13 ± 4.25
32.53± 5.09
32.6 ± 6.17
0.68
Weight (kg)
85.09 ± 6.29
82.95± 4.92
83.64 ± 5.03
0.55
Height (cm)
161.13 ± 3.64
162.8± 3.48
161.8 ± 2.59
0.38
BMI (kg/m²)
32.26 ± 1.53
31.33± 1.39
31.8 ± 1.47
0.23
Data are presented as mean ± SD or number of patients.
Table 2. TC (mg/dl)
Group A
Group B
Group C
(n = 15)
(n = 15)
(n = 15)
Baseline
205.86± 10.92
201.6± 13.46
199.13± 12.54
0.32
At the end of the
treatment
200.8 ± 11.18
191.53 ± 9.24
182.93 ± 10.68
0.0001
TC (mg/dl)
p
Data are presented as mean ± SD or number of patients. **P < 0.01.
Table 3.Ttriglycerides(mg/dl)
Group A
Group B
Group C
(n = 15)
(n = 15)
(n = 15)
Baseline
129.2± 9.75
132.46± 10.2
133± 6.39
0.45
At the end of the
treatment
122.53 ± 8.97
121.93 ± 8.55
117.06 ± 7.14
0.15
Triglycerides (mg/dl)
p
IJTRR 2016; 5 (5): 233-239
Table 4. LDL(mg/dl)
Group A
Group B
Group C
(n = 15)
(n = 15)
(n = 15)
Baseline
114.8± 10.43
111.53± 6.65
109.86± 17.13
0.53
At the end of the
treatment
108.86 ± 10.19
87.66 ± 10.54
88.4 ± 14.28
0.0001
LDL mg/dl(mg/dl)
p
Table 5. HDL(mg/dl)
Group A
Group B
Group C
(n = 15)
(n = 15)
(n = 15)
Baseline
43.26 ± 4.36
40.93± 4.83
40.6± 5.57
0.28
At the end of the
treatment
47.06 ± 4.18
50.06 ± 5.24
55 ± 6.46
0.001
HDL mg/dl(mg/dl)
DISCUSSION
The findings of the current study were
consistence with results obtained from a study
conducted by Ha and So who combined 30 min of
aerobic exercise at 60–80 % of the maximal heart rate
reserve (maximal heart rate − heart rate at rest)
[HRreserve] with 30 min of resistance training at 12–15
repetitions maximum in 16 participants aged 20–
26 years for 12 weeks. The intervention significantly
reduced the participants’ waist circumference, body fat
percentage and blood pressure values, compared with
those of non-exercising controls. The lipid profile
improved in the exercising condition, with reductions in
total cholesterol from 180.29 to 161 mg/dL, LDL
cholesterol from 112.14 to 103.57 mg/dL and
triglycerides from 97.14 to 50.43 mg/dL, although the
changes did not reach statistical significance when
compared with values in the controls. The authors
suggested that the participants was too young to elicit
the clinical and significant effects shown by previous
research in predominantly elderly or middle-aged
participants (18).
Our findings agreed with results obtained from
a study conducted byFett et al. [43] who incorporated
resistance training into circuit training sessions in which
no specific weight was specified but a specific time
duration was allocated to each exercise. Sessions
lasted 60 min and were completed three times weekly
for 1 month and four times weekly for the second
month. Significant reductions were reported in total
cholesterol (from 203 to 186 mg/dL, p < 0.01) and
triglycerides (from 122 to 91 mg/dL, p < 0.05), further
adding to the speculation that the volume of movement
may be just as important as—or even more important
than—the amount of weight lifted (19).
Our findings were consistence with results
obtained from a study conducted by Kraus et al who
investigated the impact of increasing the volume and
intensity of aerobic exercise upon the lipid profiles of
111 sedentary overweight participants, all with mild to
p
moderate dyslipidaemia. Participants were allocated to
either 6 months in a control group or 8 months in one of
three aerobic exercise groups. The three aerobic
exercise groups were high-intensity/high-volume
aerobic exercise (jogging for the calorific equivalent of
20 miles/week at an intensity of 65–80 % of the peak
aerobic capacity (VO2peak), high-intensity/low-volume
aerobic exercise (jogging for the calorific equivalent of
12 miles/week at an intensity of 65–80 % VO2peak) and
moderate-intensity/low-volume exercise (walking for the
calorific equivalent of 12 miles/week at an intensity of
40–55 % VO2peak). It was reported that the highintensity/high-volume training combination resulted in
the greatest improvements in 10 of 11 lipid variables
(LDL cholesterol decreased from 130.1 to 128.2 mg/dL,
p < 0.05; HDL cholesterol increased from 44.3 to
48.6 mg/dL, p < 0.05; triglycerides decreased from
166.9 to 138.5 mg/dL, p < 0.05). These data suggest
that in relation to aerobic exercise, both total energy
expenditure and intensity are factors in lipid reduction
(20).
Our findings were consistence with results
obtained from a study conducted by Dunn et al
whoinvestigated the effects of a 6-month aerobic
exercise training programe, which progressed from 50
to 85 % of maximum aerobic power for 20–60 min three
times weekly, and reported significant decreases in
total cholesterol (−0.3 mmol/L, p < 0.001) and in the
total:HDL cholesterol ratio (−0.3, p < 0.001)(21).
In contrast of our findings Banz et al reported
that aerobic training of sufficient intensity and duration
cause increase in high density lipoprotein level more
than resistive traning (16).
In contrast of our findings Laaksonen reported
thatthe effects of regular aerobic exercise on the lipid
profile individuals have been variable. There was
increase in the HDL / Total cholesterol ratio, without
significant changes in High density lipoprotein (HDL) or
total cholesterol, body mass index(BMI) or glycemic
control after six weeks of ergometer cycling exercise for
60 min 4 days aweek. The relative change did not differ
significantly between the training and control groups,
IJTRR 2016; 5 (5): 233-239
however. In an uncontrolled study investigating the
effect of three months of regular exercise in 20 type 1
DM men and women 22- 48 years old, LDL decreased
by 14% and HDL increased by 10%, with concomitant
weight loss and decreased percent body fat (22).
Our findings agreed with results obtained from
a study conducted by Moghadasi et al who reported
that during the 12 weeks intervention,the subjects were
trained for 45 min per session at a heart rate
corresponding to 75-80% of the maximal oxygen uptake
measured at baseline. Each participant was equipped
with a heart rate monitor to ensure accuracy of exercise
level. After 12 weeks exercise training, BMI, body fat
percent and TC decreased (23).
Our findings were consistence with results
obtained from a study conducted byKodama et al who
reported that aerobic exercise is believed to reduce the
risk of cardiovascular disease partially through
increasing serum levels of HDL- C and decreasing
serum levels of TC, TG and LDL-C improving in blood
level profile is related to the amount and intensity of the
exercise (24)
In conclusion, aerobic, resistance and
combined training are an effective modalities for
treating dyslipidemia associated with obesity.
Acknowledgements
The author would like to thank the study
participants for their time and effort
Declaration of interest: The authors report no conflict
of interest. The authors alone are responsible for the
content and writing of the paper.
REFERENCES
1. Bouchard C, Rankinen T. Exciting advances and
new opportunities. In: Clement K, Sorensen T
(eds).
Obesity:
Genomics
and
Postgenomics.Informa Healthcare: New York,
2008, pp 549–562.
2. Knight, J.A. Diseases and disorders associated
with excess body weight. Ann. Clin. Lab Sci. 2011,
41, 107–121.
3. Franssen, R.; Monajemi, H.; Stroes, E.S.;
Kastelein, J.J. Obesity and dyslipidemia. Med.
Clin. North. Am. 2011, 95, 893–902.
4. Park DH, Ransone JW. Effects of submaximal
exercise on high-density lipoprotein-cholesterol
subfractions.Int J Sports Med. 2003;24(4):245–
251.
5. Klop, B.; Castro Cabezas, M. Chylomicrons: A key
biomarker and risk factor for cardiovascular
disease and for the understanding of obesity.
Curr.Cardiovasc.Risk. Rep. 2012; 6, 27–34.
6. Durstine JL, Grandjean PW, Davis PG et al. Blood
lipid and lipoprotein adaptations to exercise: a
quantitative analysis. Sports Med. 2001;31: 1033–
1062.
7. Ren J. Leptin and hyperleptinemia-From friend to
foe for cardiovascular function.J Endocrinol.
2004;181:1–10.
8. Nammi S, Koka S, Chinnala KM, Boini KM.
Obesity: An overview on its current perspectives
and treatment options. Nutr J. 2004;3:3.
9. Blaak EE, van Aggel-Leijssen DP, Wagenmakers
AJ, Saris WH, van Baak MA. Impaired oxidation of
plasma-derived fatty acids in type 2 diabetic
subjects
during
moderate-intensity
exercise.Diabetes. 2000;49:2102–7.
10. Cooke JP, Oka RK. Does leptin cause vascular
disease? Circulation. 2002; 106:1904–05.
11. Talanian JL, Galloway SD, Heigenhauser GJ,
Bonen A, Spriet LL. Two weeks of high-intensity
aerobic interval training increases the capacity for
fat oxidation during exercise in women. J Appl
Physiol. 2007;102:1439–47.
12. Vanhees L, Geladas N, Hansen D, et al.
Importance of characteristics and modalities of
physical activity and exercise in the management
of cardiovascular health in individuals with
cardiovascular risk factors: recommendations from
the EACPR. Part II. Eur J PrevCardiol.
2012;19(5):1005–33
13. Pattyn N, Cornelissen VA, Eshghi SR, et al. The
effect of exercise on the cardiovascular risk factors
constituting the metabolic syndrome: a metaanalysis of controlled trials. Sports Med.
2013;43(2):121–33.
14. Vella, C.A, Kravitz, L, Janot, J.M . A Review of the
Impact of Exercise on Cholesterol Levels,
University of New Mexico.2001; 19(10): 48-54.
15. Green, J .High Cholesterol and Exercise: Helping
Your Clients Lower their Numbers, National
Centre on Health, Physical Activity, and Disability;
2013.
16. Banz WJ, Maher MA, Thompson WG, Bassett
DR, Moore W, Ashraf M, ZemelMB.Effects of
Resistance vs Aerobic Training on Coronary
Artery Disease Risk Factors. Experimental Biology
and Medicine.2003; 228, 434–440.
17. Williams MA, Haskell WL, Ades PA, Amsterdam
EA, Bittner V, Franklin BA, Gulanick M, Laing ST,
Stewart KJ. Resistance exercise in individuals with
and without cardiovascular disease: 2007 update:
A scientific statement from the American Heart
Association Council on clinical cardiology and
council on nutrition, physical activity, and
metabolism Circulation 2007; 116:572–584.
18. Ha CH, So WY. (2012):Effects of combined
exercise training on body composition and
metabolic syndrome factors. Iran J Public
Health.;41(8):20–6.
19. Fett C, Fett W, Marchini J. Circuit weight training
vs jogging in metabolic risk factors of
overweight/obese women. Arq Bras Cardiol.
2009;93(5):519–25.
20. Kraus W, Houmard J, Duscha B, et al.(2002):
Effects of the amount and intensity of exercise on
21.
22.
23.
24.
plasma
lipoproteins.
N
Engl
J
Med.
2002;347(19):1483–92.
Dunn
A,
Marcus
B,
Kampert
J,
et
al.(2000):Reduction in cardiovascular disease risk
factors: 6-month results from Project Active. Prev
Med.;26(6):883–92.
Laaksonen,D
(2003):
Role
of
Physical
Exercise,fitness and aerobic training in type 1
Diabetic and healthy men in relation to the lipid
profile, lipid profile, Lipid Peroxidation and the
Metabolic Syndrome J Sports Sci; (9):1541-1548.
Moghadasi, M., Heidarnia, E., Nematollahzadeh,
M., Torkfar, A., and Arvin, H. (2011):Effect of 12
Weeks High Intensity Aerobic Exercise on serum
Oxidized LDL-C in obese Middle Aged Men.
Brazilian Journal of Biomotoricity; 5(4): 263-270.
Kodama, S., Tanaka, S., Saito, Shu, M., Sone, Y.,
Onitake, S., Suzuki, E., Shimano, H., Yamamoto,
S., Kondo K., Ohashi, Y., and sone, H. (2007):
Effect of aerobic Exercise Training on serum
Levels of High-Density Lipoprotien Cholesterol.
Arch Intern Med; 167 (10): 999-1008.
6